It's normal to feel a little scared when your doctor tells you that you have a problem with a heart valve. Especially when he says that you need to have surgery for it. But the Ross Procedure that we're going to talk about today is a very successful surgical procedure that can give a new life to people with heart valve diseases, especially young people. So let's talk about this exactly, simply.
Simply put, what is the Ross Procedure?
This is a somewhat complicated, but very skillful, heart surgery. It involves using your own body parts to repair a diseased heart valve. To be precise, it involves two steps:
1. The diseased aortic valve in your heart is removed and replaced with your own healthy pulmonary valve .
2. Then, a pulmonary valve from a healthy donor is transplanted into the place where the removed pulmonary valve was.
Think of it like using a part of your own body to repair a major defect. This has many advantages over inserting an artificial valve.
Why do we need this surgery?
The aortic valve is like a very important gate in our heart. This gate opens and allows oxygen-rich, clean blood to flow from the heart to the rest of the body. It also prevents blood from flowing back into the heart between heartbeats, as this valve closes.
But sometimes this valve can become diseased. There are two main ways:
- Stenosis: This is when the valve does not open properly and becomes narrowed. This prevents the body from getting enough blood.
- Regurgitation: This is when the valve does not close properly and leaks, allowing blood to flow back into the heart.
Both of these problems can cause symptoms like fatigue and shortness of breath. If left untreated, they can increase your risk of heart failure and serious infections. The Ross Procedure removes the diseased valve and restores normal heart function.
Why choose the Pulmonary Valve instead of the Aortic Valve?
You may be wondering why such a change is being made, why not just get another artificial valve? There are several specific reasons for this.
- Pressure Resistance: The aortic valve is under a lot of pressure, so the new valve that is placed in it needs to be very durable and strong. Your own pulmonary valve is a good fit for this.
- Risks of artificial valves: There is a risk of blood clots when artificial valves are inserted. Therefore, you have to take blood-thinning medication for the rest of your life. But when you use your own tissue, that risk is almost nonexistent.
- Fitting: The pulmonary valve is very similar in size and shape to the aortic valve.
- Low-pressure zone: A donor valve is placed where the pulmonary valve used to be. That area is under low pressure. So even if that valve is a little weak, it won't have much of an impact.
Who is suitable and unsuitable for this surgery?
The Ross Procedure is not a surgery for everyone. Doctors select patients for it based on several factors.
| Those who are generally suitable for surgery | People who are generally unsuitable for surgery |
|---|---|
| People under 60 years of age. | People with autoimmune diseases such as lupus and rheumatoid arthritis. |
| People with congenital aortic stenosis. | People with connective tissue disorders such as Marfan syndrome . |
| People with other aortic valve diseases. | People with coronary artery disease, which is a blockage in more than three blood vessels in the heart. |
| People with aortic valve infection (aortic valve endocarditis). | People with pulmonary valve disease. |
The most important thing is that your cardiologist makes the final decision on whether this surgery is right for you or not.
How the surgery is performed step by step
This is a very planned surgery that takes several hours.
1. Anesthesia: First, you will be put under general anesthesia. So you will not feel anything and will have no memory of the surgery.
2. Heart-lung machine: Next, you will be connected to a cardiopulmonary bypass machine . This machine temporarily takes over the work of your heart and lungs during surgery. This allows surgeons to safely perform the surgery without stopping your heart.
3. Opening the chest: Surgeons make an incision in the middle of the chest, cutting through the breastbone on either side (sternotomy) to reach the heart.
4. Valve examination: The pulmonary valve is carefully examined to see if it is healthy enough to replace the aortic valve.
5. Valve replacement: Next, the damaged aortic valve is removed and your own pulmonary valve is carefully transplanted in its place.
6. Donor valve transplantation: Next, a valve taken from a healthy donor is transplanted into the empty space where the pulmonary valve was.
7. Cardiac resuscitation: After both valves are implanted in the correct places, your heart is restarted and you are gradually removed from the heart-lung machine. Both new valves are also checked to make sure they are working properly.
8. Completion of the surgery: Finally, the sternum is reattached and secured with wires, the incision is sutured, and covered with a clean bandage.
The benefits and possible risks of this surgery
Like any surgery, the Ross Procedure has both benefits and risks. The risks can be minimized by undergoing treatment under the supervision of an experienced surgeon who regularly performs these procedures.
| Main Benefits | Possible risks |
|---|---|
| You can lead an active life, including exercising and driving. | Widening of the blood vessel near the new valve (Aortic autograft dilation). |
| If women want to get pregnant, they can do so safely. | Heartbeat irregularities (Arrhythmia) . |
| Excellent blood circulation (hemodynamics) is achieved throughout the body. | Heart attack . |
| You don't need to take blood thinners for the rest of your life. | Excessive bleeding (Hemorrhage) . |
| Symptoms are relieved quickly. The patient feels better shortly after the surgery. | Infection . |
| Leaking or stuck valve. |
Recovery time after surgery and when to see a doctor
After surgery, you will regain consciousness in the Cardiac ICU . Initially, you may be connected to a ventilator to help you breathe. You will stay in the ICU for about five days.
It can take several months to fully recover after returning home. During this time, constipation, loss of appetite, insomnia, numbness and swelling around the incision are common.
Important: A pulmonary valve obtained from a donor does not last forever. It usually needs to be replaced after 15-20 years. Therefore, lifelong medical checkups and monitoring are very important.
If you experience any symptoms of complications after surgery, you should notify your doctor immediately . Be especially aware of the following symptoms:
- Chest pain
- Fever or chills
- Dizziness or fainting
- Coughing up blood
- Unusual bruising or bleeding
- Numbness in the limbs
- Vomiting
- Blood in the stool (bright red)
Take-Home Message
- The Ross Procedure is the best treatment for people with severe aortic valve disease, especially young people.
- This involves taking your own healthy pulmonary valve and transplanting it to replace the diseased aortic valve.
- Because you use your own tissue, you won't need to take blood-thinning medications for the rest of your life. You can also lead an active life.
- As with any surgery, there are risks involved, but these risks can be minimized by undergoing treatment under the supervision of an experienced surgeon.
- If you experience any unusual symptoms after surgery, contact your doctor immediately.
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